STUDENT NAME: MARIE EROBU

MARIE EROBU
Nutrition Prescription (NP 1.1): Calories: 1200 kcal/day (MSJ calculated kcals: 1156 +/- 10% = 1040-1272 kcal/day) IBW: 105 lbs, AF:1.3, IF:N/A,
Protein: 38-48 g/day (.8-1.0 g/kg/day older adults), Fat: 27-40 g/day (20-30% of diet), Sodium: </= 3 g/day, Fiber: >/= 25 g/day, Fluids: 1040-1272 ml/day
Assess

Priority

Diagnosis

Intervention

Monitoring

Evaluation

STUDENT NAME: MARIE EROBU

A:
Food/Nutrition-Related History
Food & Nutrient Intake:
Enjoys well-balanced meals of a meat,
vegetable and grain product. Loves ham.
Does not add salt to food. Avoids eating
excess carbohydrates. Does not eat sweets
often. Enjoys drinking water. Allergic to
chocolate.
Food and Nutrient Administration:
Oral intake.
Current diet order: continued carbcontrolled diet; self administered, related to
prior pre-diabetes Dx
Medication/Herbal Supplement Use:
aspirin, furosemide, prevastatin, neurontin,
carvedilol, donepezil, isosorbide
mononitrate, lisinopril, meloxicam,
multivitamin
Knowledge/Beliefs: Doesnt believe in
overeating or stuffing yourself. Believes
that what she eats affects her health.
Very self-sufficient. Does not want help.
Tries to assist other residents. Feels sorry
for other residents and thinks they are
going crazy.
Food and Supplies Availability:
Resident at Emeritus assisted living facility.
Has access to 3 full meals and snacks each
day.
Physical Activity:
Does light aerobics at least 3 times per

Less than optimal intake of

types of fats (saturated fat
and cholesterol) (NI-5.6.3)
RT non-ischemic
cardiomyopathy Dx and
meal selections frequently
composed of full fat meats
AEB nutrient analysis of 24
hour recall of fats (total fat=
53 grams or 37.7% of total
calories, Saturated fat= 19
grams or 36.5% of total fat
and cholesterol= 378
mg/day) and hyperlipidemia
values (exact values
cholesterol, LDL, HDL,
triglycerides.. not given in
chart I had access to). 1, 2

Recommend fat-modified diet (ND-1.2,

10833) to decrease dietary saturated fat
and cholesterol intake and increase
monounsaturated fat composition in the
diet.
Recommend menu selection assistance
(ND- 4.5) from Emeritus nutrition staff
to support dietary fat changes in client
presenting with Alzheimers disease.
Educate client on meal changes and fat
sources to choose. Continual follow-up
may be necessary to remind client of
changes to benefit clients heart health.
Provide Emeritus list of good
unsaturated, monounsaturated and
polyunsaturated fat sources, and a list of
lean, medium and high fat meat
exchanges.
Recommend limitation of one high fat
meat source per day, egg whites over
whole egg, and use of margarine in place
of butter for meal preparation.
Recommend use of monounsaturated fats
in food preparation (canola or olive oil to
prepare egg whites), as salad toppings
(avocado, nuts or olives) or as snacks
(peanut butter with crackers, pretzels or
celery.
Recommended total fat intake to be no
more than 30% of the 1200 calorie diet
(40g or 360 calories fat calories).

Monitor total fat and fat

composition of foods
selected using highlighted
menu options.
Monitor serum lipid levels
for normalization of
hyperlipidemia indicative
values: cholesterol, LDL,
HDL, triglycerides

Goals:
Blood lipid profile values
within normal limits, with:
Cholesterol < / = 200 mg/dl
LDL < / = 159 mg/dl
HDL > 45 mg/dl
Triglycerides 35-135 mg/dl
Mono, poly and unsaturated
fats will make up at least
40% of total fat composition
when fat is assessed using
nutrient analysis of 2 week
menu log.
Saturated fats will make up
less than 10% of dietary fat
using analysis of 2 week
menu log.
Caloric composition from fat
will decrease from 37.7% of
the diet to the recommended
30% of 1200 calorie diet
(360 calories +/- 10%) when
calories and calories from fat
are assessed using nutrient
analysis of 2 week menu log.
Cholesterol intake will be
< / = 300 mg/day when
assessed using analysis of 2
week menu log.

STUDENT NAME: MARIE EROBU

week. Walks the building quarters daily.

Recommend tracking of meals for 2
weeks by nutrition staff high-lighting
clients meal choices from weekly
printed kitchen menus.

Nutrition Quality of Life:

Self monitors diet by controlling
carbohydrates eaten at meals and avoiding
salts and sweets.
Anthropometric Measurements
Height: 51, Weight: 134 lb, BMI: 26.10,
IBW: 105 lbs (range IBW=94.5-115.5lbs),
%IBW: 128%
UBW: 134 lb, %UBW: 100%

Biochemical Data, Medical Tests, and

Procedures
Lab data:
Biochemical values not available. Refer to
patient medical doctor.

Excessive sodium intake (NI

5.10.1, 10716) RT meal
favorites including processed
and cured meats like ham,
and consumption of soups
AEB nutrient analysis of 24
hour recall indicating sodium
3,765 mg/day.

Educate client and staff on reduction of

processed meats in clients daily diet and
offer alternative meat sources or lowsodium modified substitution options.

Monitor overall sodium

intake using 2 week menu
log.

Goals:
Sodium intake will be < /=
3,000 mg per day when 2
week menu log is assessed
using nutrient analysis.

Recommend tracking of meals for 2

weeks by nutrition staff high-lighting
clients meals from printed kitchen
menus.

Nutrition-Focused Physical Findings

Physical appearance, Muscle/fat wasting:
Physical appearance is healthy, slightly
overweight. Client is ambulatory.

Client History
Personal History:
Never married. Twin sister passed away last
year. Client very affected by her death.
Speaks of her often. Older brother passed
away years ago. Younger brother living in

Monitor processed meat

intake as sources of sodium
using 2 week menu log.

Educate Emeritus nutrition staff on soup

and meal preparation using limited
sodium and substituting non-sodium
spice blends.

Tests: Tests not available. Refer to patient

medical doctor.

Swallow Function, Appetite, Affect:

Normal oral intake. Has an appetite and
participates in all meals offered each day.

Recommend moderate sodium diet (ND1.2, 10838) of no more than 3,000 mg

sodium/day.

Inadequate fiber intake (NI5.8.5) RT choosing fruit in

juice form and low grain
intake and hyperlipidemia
AEB nutrient analysis of 24
hour recall indicating fiber of
11.45 g/day.

Recommend fiber-modified diet (ND-1.2

10834) to increase fiber to minimum of
25g/day.
Educate client and staff on client
consumption of whole fruits over juice.
Educate client and staff on increased

Monitor total fiber intake

using 2 week menu log.
Monitor whole fruit intake,
whole grain intake and
maintenance of vegetable
intake using 2 week menu
log.

Goals:
Fiber will be an average of
25g per day or greater when
fiber is assessed using
nutrient analysis of 2 week
menu log.

STUDENT NAME: MARIE EROBU

Des Moines, Iowa. Calls weekly and

occasionally comes to visit.
Religious affiliation: Baptist, Christian.

intake of grains with emphasis on whole

grain carbohydrates as a soluble fiber
source.

Medical/Health/Family History:
Alzheimers Dx., hyperlipidemia, nonischemic cardiomyopathy, hypovitaminosis
D
Prior pre-diabetes Dx

Recommend tracking of meals for 2

weeks by nutrition staff high-lighting
clients meals from printed kitchen
menus.

The MyPlate 4 oz grain

servings recommendation
will be met daily when fiber
sources are assessed using
the nutrient analysis of 2
week menu log
At least 50% of the 4 oz My
Plate recommended grain
requirement will be whole
grain when fiber sources are
assessed using the nutrient
analysis of 2 week menu log.

Treatments and CAM Use: cardiac

pacemaker procedure
Social History:
Decreased mental functioning due to
Alzheimers Dx.
Displays bossy and aggressive behavior
toward staff and other Emeritus residents.
Previously an athletics teacher: swimming
and aerobics classes

At least 50% of fruit intake

will come from whole fruit
sources when fiber sources
are assessed using the
nutrient analysis of 2 week
menu log.
If fiber goals not met within
1 month, reassess and
consider the addition of a
daily fiber supplement such
as Metamucil to the meal
plan
4

Inadequate Vitamin D intake

(NI5.9.1, 10681) related to
current low vitamin D dense
food intake and low exposure
to sunlight AEB Vitamin D
deficiency Dx and nutrient
analysis of 24 hour recall.

Recommend increased intake of Vitamin

D and Vitamin D fortified food sources
(ND-1.2 10837) such as fish with skins
and fortified cereals and grains.
Recommend continued use of daily
Vitamin D supplement.
Recommend continuation of
multivitamin.

Monitor menu log for

vitamin D and vitamin D
fortified food intake.
Monitor biochemical vitamin
D deficiency status/lab
values.

Goals:
Vitamin D intake by food
sources will be increased to
at least 75% of the RDA or
10 mcg/day using the 2 week
menu log to assess nutrient
intake.
Vitamin D biochemical

STUDENT NAME: MARIE EROBU

Recommend daily walks to include

walking in outdoor quarters between 10
AM-3PM twice per week for 5-30
minutes.

values will be within normal

limits serum D3 of 15-75
pg/ml or 39-195 nmol/L ;
Plasma D3 of 15-80 ng/ml or
37-200 nmol/L in the
summer, 14-42 ng/ml or 35105 nmol/L in the winter .
If vitamin D status not
improving within 1 month,
reassess and consider the
addition of fish oil
supplement to the meal plan.

Priority Intervention Evidence-Based Practice Footnote: Previous studies indicate a low fat diet to be beneficial in CVD risk factors, but new studies have questioned the impact over time.
Current evidence suggests that modification of the diet using a low fat diet alone does not improve the risk or status of CVD in a patient. An eight year randomized controlled trial found no
significant reduction in CVD risk factors based on a low fat diet. The greatest risk reductions were seen in those who consumed lower saturated fat intakes. More focused interventions modifying
the composition of fat types within the diet could prove to be more beneficial.
Reference:
Howard B. V., Van Horn L., Hsia J., Manson, J., Stefanick, M., Wassertheil-Smoller, S., & ... Kotchen J. M. (2006). Low-fat dietary pattern and risk of cardiovascular disease: The
women's health initiative randomized controlled dietary modification trial. Journal of the American Medical Association. 295(6):655-666. doi:10.1001/jama.295.6.655
2

Priority Intervention Evidence-Based Practice Footnote: Results from a review of 18 various fat modification studies examined the impact of low fat diets and the impacts of mono, poly and
unsaturated fats on CVD risk. The findings indicate an increase in triglycerides may occur in individuals who maintain their weight and consume a low fat diet (maximum +37.3% triglyceride
increase observed). This increase offsets beneficial aspects of the low fat diet on lowering cholesterol levels and CVD risk. Diets high in monounsaturated fats (MUFA), however, were shown to
reduce cholesterol and serum LDL. HDL maximum increase in a low-fat diet was less than that of a high MUFA diet (+1.8%, +6.0% respectively). High MUFA diets could be beneficial to CVD
risk factors, increasing HDL while decreasing LDL and cholesterol.
Reference:
Kris-Etherton, P. M., Zhao, G., Pelkman, C. L., Fishell, V. K., & Coval, S. M. (2000). Beneficial effects of a diet high in monounsaturated fatty acids on risk factors for cardiovascular disease.
Nutrition in Clinical Care, 3(3), 153-162.

STUDENT NAME: MARIE EROBU

Reference Resources:
Academy of Nutrition and Dietetics. (2013). International dietetics & nutrition terminology reference manual: Standardized language for the nutrition care process 4th Ed. Chicago, IL:
Academy of Nutrition and Dietetics.
National Institutes of Health Office of Dietary Supplements. (2011). Vitamin D: Fact sheet for health professionals. Retrieved from http://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/
Nelms, M., Sucher, K., Lacey, K., & Roth, S. (2011). Nutrition Therapy and Pathophysiology 2nd Ed. Belmont, CA: Wadsworth, Cengage Learning.
Piland, C., Adams, K. (2009). Pocket resource for nutrition assessment 7th Ed. Dietetics in Health Care Communities.